Search

Objectives: To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier’s gangrene (FG).Patients and methods: Data regarding patients admitted for FG at nine Italian Hospitals (March 2007–June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A – one microorganism; Group B – two microorganisms; Group C – more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease’s features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick’s nonparametric test for trend across ordered groups were used.Results: Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p< 0.001), procalcitonin (p= 0.02) and creatinine (p= 0.03). Scoring systems were associated with the number of microorganisms detected (p< 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p< 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p= 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival.Conclusion: Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.

Objective: To describe a left epididymitis and para-aortical involvement caused by Mycobacterium tuberculosis hominisreactivation after bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer.Patient and methods: A Caucasian male, aged 76 years, exposed to bacillus Calmette-Guérin for a high-grade non-muscle-invasive bladder cancer in 2015, reported painful and progressive left scrotal swelling with purulent discharge from a cutaneous fistulous track that yielded, on liquid culture, a pan-susceptible Mycobacterium tuberculosis hominisstrain. Moreover, after 6 months of anti-tuberculosis treatment, an abdominal peri-aortic mass, sized 4 cm, was found and a surgical biopsy showed necrotizing granulomas; however, although smear microscopy and Xpert MTB/Rif™ performed on fresh biopsy sample were positive, liquid cultures resulted negative, indicating treatment efficacy.Results: Numerous peculiar and multi-organ involvement due to BCGitis after intravesical immunotherapy have been previously described, including 17 scientific articles about epididymitis, however, no reports so far showed reactivation of Mycobacterium tuberculosis hominisafter bacillus Calmette-Guérin treatment.Conclusion: Although BCGitis is more prevalent in patients undergoing bacillus Calmette-Guérin instillation for non-muscle-invasive bladder cancer, tuberculosis by other species of Mycobacterium tuberculosisshould be always ruled out by molecular and conventional microbiology in patients with a history of Mycobacterium tuberculosis hominisexposure.

Aim Thrombosis secondary to renal closed abdominal trauma is a rare event, most of the time it is clinically silent. We report here our experience.Materials and Methods. This is the case of a boy came to our observation after a road trauma with motorbike fall-out. The boy arrived in ED for head injury. The patient, stable for haemodynamics, had lacerated and contused injuries at pelvis and right buttock level. He underwent chest x-rays, brain CT and neurosurgery examination: all resulted negative. There was no macrohematuria, nor lumbar pain. Objectively abdomen was treatable. The patient was referred to temporary observation for 12 hours when he was asked to undergo abdomen ultrasound, which showed no documented lesions except for fluid collection at the pelvic level. To rule out all doubts, the patient had an abdominal CT scan, which showed a silent left kidney with suspected thrombosis at left renal level. The patient was sent to our attention after 15 hours: we decided to perform immediately selective arteriography with thrombus lysis. The arteriography documented a massive thrombosis. The thrombus lysis was impossible to be performed. To maintain the perfect functionality of the contralateral kidney we decided not to proceed further, but to perform only left nephrectomy. During surgery mesocolon laceration occurred, so the patient underwent also colic resection.Discussion. Thrombosis secondary to a closed renal abdominal trauma is an uncommon event, with little clinical expression. It is the consequence of an injury. Deceleration produces arterial dissection, which alters the blood flow to the kidney, which is then twisted and complicated with renal thrombosis. Quite common is the association with diaphragmatic rupture or urethral detachment. The alterations of renal parenchyma in the early hours are detectable only through CT scan, which represents the method of election, and which can highlight a functionally silent kidney.Conclusions. Renal thrombosis requires that diagnosis is done within the first 12 hours; a rapid revascularization should be promptly attempted.

The Authors analyse the possible therapies for cryptorchidism on the basis of current knowledge and with the aim of being able to choose the age in which to act. The latest laparoscopic therapeutic method is reported by the few authors who are using it, although its real advantages have still to be confirmed.

Riassunto— The Authors report on the case histories and results of orchiopexy in a selected group of 143 patients with cryptorchidism. The methods of treatment and the results are analysed. Subjecting patients to orchiopexy before 2 years of age in order to Preserve fertility and avoid neoplastic development is still a controversial subject.

From a review of Literature on the subject, the Authors have followed developments in diagnosing cryptorchidism. The objective examination is still fundamental, but nowadays ultrasound, NMR, CT, phlebography and laparoscopy can be used. Surgical exploration remains a valid method for completing the above examinations.

There are still many unresolved problems regarding cryptorchidism, so a review of recent diagnostic and therapeutic methods is of interest. The authors analyse the results of a retrospective survey of 180 cryptorchid patients operated about 25 years ago. A systematic approach at birth and periodic controls would help early diagnosis as well as making it easier to distinguish between true cryptorchidism and retractile testis.

Infertility and cancer in cryptorchids are real possibilities, even if the latter has been greatly reappraised. The risk from intrinsic causes can benefit greatly from early hormonal therapy with HCG and LH-RH, while extrinsic ones can be treated by early orchiopexy. A randomised study would be useful to establish if the best age is before the 7th or the 18th month of life.